The Culture & End-of-Life e-learning course introduces a step-wise process for understanding and incorporating culture in patient care along with six case studies with patients from diverse cultures. The introduction is followed by modules on spirituality and religion, complementary and alternative medicine, and ethical dilemmas. All modules are based on case studies reflecting diversity in patients and healthcare providers and incorporate process-based tools for culturally competent healthcare. In Phase II, we propose to 1) expand and enhance the case-based e-learning course, 2) develop and pilot test an Interactive Video Assessment for cultural competency and end- of-life care, 3) submit the full course to formal usability testing, and 4) evaluate the effectiveness of the e-learning course, resident physicians using multiple measures in a three-group, pre-post randomized trial We intend to produce a convenient, low-cost resource for cultural competency training and end-of-life education. We expect that Graduate Medical Education programs, , healthcare organizations, membership organizations, and continuing medical education (C.M.E.) vendors will purchase Culture & End-of-Life for their physicians and other clinical staff. Our goal is to improve the quality of end-of-life care by enhancing providers' knowledge, attitudes skills for culturally-competent care. Abstract/Relevance Today, people at the end-of-life are older and more diverse than they were just twenty years ago. In poorer health, and needing more services, the elderly are reshaping end- of-life care in the U.S. For most individuals, the end of life comes after a series of decisions about medical care, ultimately including decisions to terminate or withhold further interventions. "Living with dying" and the decisions to be made along the way pose new challenges for both patients and health care providers. Health care providers are being asked to initiate early and meaningful discussions about preferences for end- of-life care with an increasingly diverse patient population. The Culture & End of Life e- learning course teaches skills for providing culturally sensitive end-of-life care that do not require prior knowledge of specific cultures. [unreadable] [unreadable] [unreadable] [unreadable]